A new molecular mechanism for severe myoclonic epilepsy of infancy: Exonic deletions in SCN1A

We examined cases of severe myoclonic epilepsy of infancy (SMEI) for exon deletions or duplications within the sodium channel SCN1A gene by multiplex ligation-dependent probe amplification. Two of 13 patients (15%) who fulfilled the strict clinical definition of SMEI but without SCN1A coding or splicing mutations had exonic deletions of SCN1A.

Updated Global and Oceanic Mercury Budgets for the United Nations Global Mercury Assessment 2018

In support of international efforts to reduce mercury (Hg) exposure in humans and wildlife, this paper reviews the literature concerning global Hg emissions, cycling and fate, and presents revised global and oceanic Hg budgets for the 2018 United Nations Global Mercury Assessment. We assessed two competing scenarios about the impacts of 16th - late 19th century New World silver (Ag) mining, which may be the largest human source of atmospheric Hg in history. Consideration of Ag ore geochemistry, historical documents on Hg use, and comparison of the scenarios against atmospheric Hg patterns in environmental archives, strongly support a "low mining emission" scenario. Building upon this scenario and other published work, the revised global budget estimates human activities including recycled legacy emissions have increased current atmospheric Hg concentrations by about 450% above natural levels (prevailing before 1450 AD). Current anthropogenic emissions to air are 2.5 ± 0.5 kt/y. The increase in atmospheric Hg concentrations has driven a ∼ 300% average increase in deposition, and a 230% increase in surface marine waters. Deeper marine waters show increases of only 12-25%. The overall increase in Hg in surface organic soils (∼15%) is small due to the large mass of natural Hg already present from rock weathering, but this figure varies regionally. Specific research recommendations are made to reduce uncertainties, particularly through improved understanding of fundamental processes of the Hg cycle, and continued improvements in emissions inventories from large natural and anthropogenic sources.

Saccharomyces cerevisiae thermal inactivation kinetics combined with ultrasound

Inactivation kinetics of Saccharomyces cerevisiae during thermal treatments at moderate temperatures (45.0, 47.5, 50.0, 52.5, or 55.0 degrees C) combined with application of 20 kHz of ultrasound were evaluated. S. cerevisiae inactivation under the combined effects of heat and ultrasound followed first-order reaction kinetics, with decimal reduction times (D) that varied from 22.3 to 0.8 min. D values in treatments that combined heat and ultrasound were significantly smaller (P < 0.05) than D values obtained for thermal treatments and were more noticeable at temperatures below 50 degrees C. The dependence of the D value on temperature had a significantly (P < 0.05) greater z value for combined treatments. Yeast heat inactivation kinetics revealed decreased thermal resistance caused by ultrasound.

Prognostic value of echocardiography in hospitalized patients with pericardial effusion

It is often difficult to predict outcome in hospitalized patients with pericardial effusion. To address this issue, the prognostic value of echocardiography was studied in 187 hospitalized patients diagnosed with pericardial effusions over a 1-year period. The index echocardiogram showed that 11 effusions were large (6%), 39 were moderate (21%), and 137 were small (73%). Right ventricular collapse was present in 7% of cases (13 of 178), right atrial collapse in 12% (21 of 168), and inferior vena cava (IVC) plethora with blunted response to respiration in 35% (46 of 132). During the course of hospitalization, 9 patients (5%) had cardiac tamponade and 16 (9%) had cardiac tamponade, pericardiocentesis and/or surgical drainage (combined end point). By univariate analysis, each echocardiographic sign was associated with both cardiac tamponade and the combined end point (p less than or equal to 0.01 for comparisons with size and right-sided chamber collapse; p less than or equal to 0.07 for comparisons with IVC plethora). When the data were analyzed with logistic regression modeling, effusion size was the most powerful predictor of outcome (cardiac tamponade: odds ratio 51, 95% confidence interval 3.5-729, p = 0.004; combined end point: odds ratio 78, 95% confidence interval 14-421, p = 0.0001), and neither right-sided chamber collapse nor IVC plethora with blunted response to respiration retained significant associations. It is concluded that echocardiographically determined effusion size is a powerful predictor of outcome in hospitalized patients with pericardial effusion, and that right-sided chamber collapse and IVC plethora with blunted response to respiration add little if any additional prognostic information.

Partial NSD1 deletions cause 5% of Sotos syndrome and are readily identifiable by multiplex ligation dependent probe amplification

BACKGROUND

Most cases of Sotos syndrome are caused by intragenic NSD1 mutations or 5q35 microdeletions. It is uncertain whether allelic or genetic heterogeneity underlies the residual cases and it has been proposed that other mechanisms, such as 11p15 defects, might be responsible for Sotos cases without NSD1 mutations or 5q35 microdeletions.

OBJECTIVE

To develop a multiplex ligation dependent probe amplification (MLPA) assay to screen NSD1 for exonic deletions/duplications.

METHODS

Analysis was undertaken of 18 classic Sotos syndrome cases in which NSD1 mutations and 5q35 microdeletions were excluded. Long range polymerase chain reaction (PCR) was used to characterise the mechanism of generation of the partial NSD1 deletions.

RESULTS

Eight unique partial NSD1 deletions were identified: exons 1-2 (n = 4), exons 3-5, exons 9-13, exons 19-21, and exon 22. Using long range PCR six of the deletions were confirmed and the precise breakpoints in five cases characterised. This showed that three had arisen through Alu-Alu recombination and two from non-homologous end joining.

CONCLUSIONS

MLPA is a robust, inexpensive, simple technique that reliably detects both 5q35 microdeletions and partial NSD1 deletions that together account for approximately 15% of Sotos syndrome.

The effectiveness of treatment for Severe Acute Malnutrition (SAM) delivered by community health workers compared to a traditional facility based model

BACKGROUND

In most health systems, Community Health Workers (CHWs) identify and screen for severe acute malnutrition (SAM) in the community. This study aimed to investigate the potential of integrating SAM identification and treatment delivered by CHWs, in order to improve the coverage of SAM treatment services.

METHODS

This multicentre, randomised intervention study was conducted in Kita, Southwest Mali between February 2015 and February 2016. Treatment for uncomplicated SAM was provided in health facilities in the control area, and by Community Health Workers and health facilities in the intervention area. Clinical outcomes (cure, death and defaulter ratios), treatment coverage and quality of care were examined in both the control and intervention group.

RESULTS

Six hundred ninety nine children were admitted to the intervention group and 235 children to the control group. The intervention group reported cure ratios of 94.2% compared to 88.6% in the control group (risk ratio 1.07 [95% CI 1.01; 1.13]). Defaulter ratios were twice as high in the control group compared to the intervention group (10.8% vs 4.5%; RR 0.42 [95% CI 0.25; 0.71]). Differences in mortality ratios were not statistically significant (0.9% in the intervention group compared to 0.8% in the control group). Coverage rates in December 2015 were 86.7% in intervention group compared to 41.6% in the control (p < 0.0001).

CONCLUSIONS

With minimal training, CHWs are able to appropriately treat SAM in the community. Allowing CHWs to treat SAM reduces defaulter ratios without compromising treatment outcomes and can lead to improved access to treatment.

TRIAL REGISTRATION

Retrospectively registered in ISRCTN Register with ISRCTN33578874 on March 7th 2018.

Probabilistic modeling of Saccharomyces cerevisiae inhibition under the effects of water activity, pH, and potassium sorbate concentration

Probabilistic microbial modeling using logistic regression was used to predict the boundary between growth and no growth of Saccharomyces cerevisiae at selected incubation periods (50 and 350 h) in the presence of growth-controlling factors such as water activity (a(w); 0.97, 0.95, and 0.93), pH (6.0, 5.0, 4.0, and 3.0), and potassium sorbate (0, 50, 100, 200, 500, and 1,000 ppm). The proposed model predicts the probability of growth under a set of conditions and calculates critical values of a(w), pH, and potassium sorbate concentration needed to inhibit yeast growth for different probabilities. The reduction of pH increased the number of combinations of a(w) and potassium sorbate concentration with probabilities to inhibit yeast growth higher than 0.95. With a probability of growth of 0.05 and using the logistic models, the critical pH values were higher for 50 h of incubation than those required for 350 h. With lower a(w) values and increasing potassium sorbate concentration the critical pH values increased. Logistic regression is a useful tool to evaluate the effects of the combined factors on microbial growth.

Physical growth and bone age of survivors of protein energy malnutrition

Early postnatal malnutrition produces delay in growth and developmental processes, and children from a low socioeconomical level where undernutrition is prevalent are shorter than those from higher socioeconomic levels. We examined the effects of severe and early protein energy malnutrition on growth and bone maturation. We studied 40 preschool children who had been admitted to hospital in infancy with protein energy malnutrition and 38 children from the same socioeconomic level, paired for age and sex, who had never been malnourished. Growth measurements were made over a period of 4-6 years, and bone age was determined in a subgroup through wrist roentgenograms. Results showed a correlation between protein energy malnutrition, birth weight of infants, and mother's height and head circumference. The group with protein energy malnutrition showed a significant delay in stature after four years, especially the girls (p less than 0.001). Weight:height ratio was reduced in boys compared with controls but not in girls. Both groups showed a delay in bone maturation, but there were no significant differences between them. We found a positive correlation between bone age and arm fat area in control boys and between bone age and height for age in boys with protein energy malnutrition. The finding that rehabilitated children were shorter than the control group but had similar bone age at follow up suggests that genetic or prenatal factors were important in their later poor growth, and this suggestion is supported by their smaller birth size and the smaller size of their mothers.

A community trial of fluoridated powdered milk in Chile

OBJECTIVE

To demonstrate the effectiveness of a dental caries prevention program on the primary dentition of Chilean rural children, using fluoridated powdered milk and milk derivatives.

METHODS

Fluoridated milk and milk-cereal was given to about 1000 preschool children in Codegua, a rural community located in the 6th Region of Chile, using the standard National Complementary Feeding Program (PNAC). The daily fluoride dose from fluoridated powdered milk was estimated at 0.25 mg for infants (0-2 years old), 0.5 mg for children aged 2-3 years and 0.75 for children aged 3-6 years. Cross-sectional samples of children aged 3-6 years were taken from Codegua (study community) from 1994 to 1999 and from La Punta (control community) from 1997 and 1999.

RESULTS

Significant reductions (72%) were observed in the dmfs indices in the 3-6-year-old groups in Codegua, when comparing 1999 with 1994 data. In 1999, children in the study community showed significantly lower dmfs than children in the control community (41%). The proportion of caries-free children in the study community increased after 4 years of program implementation (from 22.0% to 48.4%).

CONCLUSION

Under Chilean rural conditions, fluoridation of powdered milk distributed through the PNAC is an effective caries prevention alternative for areas where water fluoridation might not be feasible.

[Pattern of the distribution of total cholesterol and cHDL cholesterol Spanish children and adolescents: RICARDIN Study]

BACKGROUND

The RICARDIN Study multicenter study of cardiovascular risk factors in children and adolescents has described the standards of normality of blood cholesterol levels in the Spanish school population. The objective of the present study was to compare mean values of cholesterol between different regions of Spain, and to compare the global mean with a pool international study. Also, the pattern of total cholesterol and cHDL by age and sex using mathematical model is described, and comparison with two international studies carried out in USA and Japan is performed.

SUBJECTS AND METHODS

10,683 children aged 6 to 18 were selected from 7 different Spanish provinces (Madrid, Vizcaya, Lugo, Badajoz, Murcia, Asturias and Barcelona). Blood samples were obtained by capilar puncture (Reflotron).

RESULTS

Mean values of total cholesterol was different among provinces, and globally, were lower than the international pooled population, although the pattern observed in each population was very similar. Total cholesterol curve for Spanish boys showed a curvilinear trend that can be estimated through a cubic function that explains 89% of observed data, while for girls the best estimate was obtained through an inverse function (R2 = 0.40). cHDL for boys showed a cubic function as the best estimate (R2 = 0.90), while for girls the best estimate was obtained through a quadratic function (R2 = 0.59).

CONCLUSIONS

There are important physiological variations of total cholesterol level by age and sex in children and adolescents. The pattern of cholesterol does not follow a linear model but a curvilinear one, that need to be considered in clinically assessing individual determinations of cholesterol, since highest percentiles can vary by age and sex.

Development of a Shelf-Stable Banana Purée by Combined Factors: Microbial Stability

A preservation process based on the "hurdle" effect for obtaining a shelf-stable banana purée was developed. The microbial stability of the purée was challenged with inoculation of osmophilic and non-osmophilic yeasts, various molds, Bacillus coagulans , Clostridium pasteurianum and Clostridium butyricum . It was shown that growth of both native and inoculated flora may be prevented for at least 120 days storage in banana purée by adjusting water activity (a_w) to 0.97, pH to 3.4, adding 250 ppm of ascorbic acid (AA), 100 ppm of potassium sorbate (KS) and 400 ppm of sodium bisulphite (NaHSO₃), and applying a mild heat treatment.

Simultaneous determination of CXCL7 chemokine and MMP3 metalloproteinase as biomarkers for rheumatoid arthritis

This paper reports the preparation of the first dual electrochemical immunosensor for the simultaneous determination of the CXCL7 chemokine and the MMP3 metalloproteinase as relevant biomarkers for the better diagnosis and monitoring of rheumatoid arthritis derived from the multiple biomarkers measurement. The developed immunosensor involves the use of carboxylated magnetic beads (MBs) and dual screen-printed carbon electrodes (SPdCEs). Sandwich-type configurations implied the covalent immobilization of specific anti-CXCL7 (cAb1) or anti-MMP3 (cAb2) capture antibodies onto MBs and the use of biotinylated detection antibodies with further labelling with HRP-Strept conjugates. The resulting MBS bioconjugates were magnetically captured on the respective working electrode of the SPdCE and the determination of the antigens was accomplished by measuring the amperometric responses of H₂O₂ mediated by hydroquinone (HQ) at a potential value of -0.20 V. The dual immunosensor provided calibration plots with linear ranges between 1 and 75 ng mL^-1 (CXCL7) (R² = 0.997) and from 2.0 to 2000 pg mL^-1 (MMP3) (R² = 0.998) with detection limits of 0.8 ng mL^-1 and 1.2 pg mL^-1, respectively. The assay took 2 h 20 min for the simultaneous determination of both biomarkers. The dual immunosensor was successfully applied to the analysis of human serum from positive and negative RA patients.

Development and quality assessment of a turbid carrot-orange juice blend processed by UV-C light assisted by mild heat and addition of Yerba Mate (Ilex paraguariensis) extract

Carrot-orange juice processed by UV-C (10.6 kJ/m²) assisted with mild heat (H, 50 °C) and yerba mate addition (E) was obtained. UV-C/H + E treated juice was examined for native flora, polyphenol content (PC), total antioxidant activity (TAA), colour, turbidity, °Brix and pH along storage (4 °C). Consumer profiling studies were performed. UV-C/H + E provoked 2.6-5.7 native flora log reductions, preventing from recovery during 24 day-storage. The UV-C/H + E juice exhibited a significant increase in PC (720.2 µg/mL) and TAA (5.5 mg/mL) compared to untreated (PC = 205.0 µg/mL/TAA = 0.7 mg/mL) and single treated juices (PC = 302.1-408.0 µg/mL/TAA = 0.7-2.4 mg/mL), remaining constant throughout storage. UV-C/H + E juice exhibited scarce changes in colour. Nevertheless, increases in °Brix and turbidity were observed compared to single treatments. A cluster sensory analysis revealed that one group showed a marked interest in UVC/H + E beverages with herbal taste and strong aroma. CATA question revealed that some improvements should be introduced in order to satisfy the consumers' ideally beverage.

Estimation of optimal concentration of fluoride in drinking water under conditions prevailing in Chile

The purpose of this comparative study of caries and dental fluorosis experience in Chilean children was to estimate the optimal range of fluoride concentration in tap water under conditions currently prevailing in Chile. The sample included 2431 schoolchildren 7, 12 and 15 years old, life-long residents of five communities with fluoride concentrations in their tap water in the range 0.07-1.1 mg/L. The study population received an oral clinical examination including caries experience and an enamel fluorosis evaluation of the permanent dentition (Dean's scoring system). For 15-year-old children, the DMFT index changed from 5.06 to 2.60, and for 12-year-olds it changed from 3.10 to 1.36 when fluoride water concentration changed from 0.07 to 1.10 mg/L. For 7-year-old children the dmft index correspondingly changed from 3.67 to 1.59. The relationship between DMFT for 12-year-olds and water fluoride concentration was best fitted by a logarithmic function (r2=0.98). The Community Fluorosis Index (CFI) was used to assess enamel fluorosis in the study population, and it showed a linear relationship (r2=0.983) with increasing fluoride concentration of water for the 12-year-old group. Results obtained suggest that under current Chilean conditions, the optimal range of fluoride concentration in potable water should lie in the 0.5-0.6 mg/L range.

Effects of 4-aminopyridine on pacemaker activity of frog sinus venosus

The effects of low concentrations of 4-aminopyridine (4-AP) were studied on the frog sinus venosus by means of intracellular microelectrodes. 4-AP depressed spontaneous automaticity. This effect was not reversed by atropine. 4-AP also prolonged the sinus action potential repolarization and slowed the rate of diastolic depolarization. These effects are attributed to blockade of potassium conductance.

Lack of in vivo embryotoxic and genotoxic activities of orally administered stem bark aqueous extract of Mangifera indica L. (Vimang)

Mango (Mangifera indica L.) stem bark aqueous extract (MSBE) is a new natural product with antioxidant, anti-inflammatory and immunomodulatory effects known by the brand name of its formulations as Vimang. Previously, the oral toxicity studies of the extract showed a low toxicity potential up to 2000 mg/kg. This work reports the results about teratogenic and genotoxicologic studies of MSBE. For embryotoxicity study, MSBE (20, 200, or 2000 mg/kg/day) was given to Sprague-Dawley rats by gavage on days 6-15 of gestation. For genotoxicity, MSBE was administered three times during 48 h to NMRI mice. Cyclophosphamide (50 mg/kg) was used as a positive control. No maternal or developmental toxicities were observed when the rats were killed on day 20th. The maternal body-weight gain was not affected. No dose-related effects were observed in implantations, fetal viability or external fetal development. Skeletal and visceral development was similar among fetuses from all groups. No genotoxicity was observed in bone marrow erythrocytes and liver cells after administration. MSBE appears to be neither embryotoxic nor genotoxic as measured by bone marrow cytogenetics in rodents.

Caries experience and fluorosis prevalence in Chilean children from different socio-economic status

Caries experience and enamel fluorosis prevalence in 8-year-old children belonging to different socio-economic classes were determined in two Chilean twin cities that are served by optimally fluoridated community water from the same waterworks facility. Low socio-economic status (LSES) children had a higher mean dmft and DMFT indices (P < 0.001) than high socioeconomic status (HSES) children. Prevalence of enamel fluorosis in the permanent teeth of LSES children was 0.79, significantly higher (chi 2 = 9.0; P < 0.003) than the value 0.59 found in HSES children. The proportion of Dean's scores 2, 3, 4 and 5 in first molars, mandibular and maxillary incisors in LSES children was higher than in HSES children (P < 0.001). Differences in prevalence and severity of enamel fluorosis between both groups are tentatively attributed to a different pattern of tap water and tea consumption at pre-school ages. Suggestions are advanced to minimize the undesirable prevalence and severity of enamel fluorosis.

Fluoride bioavailability from disodium monofluorophosphate fluoridated milk in children and rats

The aim of the present work was to study the usefulness of disodium monofluorophosphate (MFP) as a milk-fluoridating agent by measuring the bioavailability of F from MFP in milk relative to that of F from NaF in water. Long-term (multiple-dose) studies were performed on rats measuring F bone uptake. The relative F absorption from MFP in milk was also determined in preschool children by means of 24-hour F urinary excretion. In both studies F absorption was determined either under fasting conditions or when F ingestion occurred together with food intake. The results show that F absorption from MFP in milk is as high as that of NaF in water under fasting conditions and that the F bioavailability decrease from NaF in water is more important than that of MFP in milk when F ingestion occurs simultaneously with food intake.

Electrophysiological characteristics of cardiac pacemaker cells of the frog Caudiverbera caudiverbera

1. The cardiac pacemaker cells of the frog Caudiverbera caudiverbera are centrally located in the sinus venosus. These cells are rounded, smaller than contractile fibres and have large nuclei. 2. Intracellular recording confirmed the existence of primary and transitional pacemaker cells. 3. Action potentials from primary cells were resistant to blockade by tetrodotoxin (TTX), but were abolished by verapamil suggesting that their bioelectric activity is dependent on a slow inward current. 4. Transitional cells appeared to have two different inward currents contributing to the upstroke: a fast TTX-sensitive and a slow verapamil-sensitive current.

Agrupamiento de factores de riesgo cardiovascular en hijos obesos de padres con hipertensión esencial

INTRODUCTION

The prevalence of obesity in industrialized countries is increasing and is closely related to essential hypertension (EHT) in adolescents.

OBJECTIVE

To analyze the prevalence of obesity and its association with other known cardiovascular risk factors in a sample of children and young adults with at least one parent with EHT.

METHODS

The EHT group consisted 51 children and young adults (28 males [aged 5.4-25.6 years]) with at least one parent with EHT. The control group comprised 73 healthy normotensive children and young adults (43 males [aged 7.2-25.2 years]) who completed the follow-up visits of the RICARDIN study. Blood pressure (BP) was measured with a standardized technique using a mercury sphygmomanometer. A 12-hour fasting blood sample was taken for lipid profile and high sensitivity C-reactive protein (CRP) determinations. Financial support: FIS 03/0350, ESV Foundation Grant, 2003.

RESULTS

The prevalence of obesity was five times higher in the EHT group than in controls (19.6% vs. 4.1%, p = 0.007). In this group, obese subjects showed higher systolic BP (122.0 vs. 110.4 mmHg p = 0.004) and lower high-density lipoprotein cholesterol (HDL-C) levels (47.6 vs. 58.0 mg/dl, p < 0.05). After adjustment for age and systolic BP, obese subjects in the EHT group showed significantly higher CRP values than non-obese subjects in this group (p = 0.024).

CONCLUSIONS

The prevalence of obesity is higher in the offspring of parents with EHT than in non HT-prone subjects. Clustering of other additional risk factors indicates the need for high-risk preventive interventions in this group of children and young adults.

[Co-authorship and Spanish pediatric scientific collaboration networks (2006-2010)]

INTRODUCTION

Scientific collaboration is very important, as it is the basis of the scientific development of every discipline. The aim of this paper is to identify the indicators of scientific collaboration and co-authorship networks of Spanish researchers and institutions publishing in national and international paediatric, multidisciplinary or other knowledge areas journals during the period 2006-2010.

METHODS

The papers studied were obtained from the databases including, Science Citation Index Expanded, Scopus, Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud, by means of applying different search profiles. All the papers signed by co-authors were quantified in order to identify the authorship and institutional collaboration networks. Furthermore the degree, betweenness index, and closeness index were obtained as a measurement of the structural analysis. Co-authorships were represented graphically by the network analysis and display software Pajek.

RESULTS

A total of 7971 articles were published during the period 2006-2010, with 90.55% completed in collaboration. Using a threshold of 10 or more co-authorships, 77 research groups in Pediatrics were identified. Most papers were published in collaboration between institutions of the same Autonomous Community (42.28%), and 14.84% with international collaboration. The analysis of institutional participation enabled a large nucleus or institutional collaboration network to be identified, with 52 linked institutions. International collaboration was led by the USA and European countries, such as United Kingdom, Germany and Italy.

DISCUSSION

Authors, institutions and the most active working groups in Spanish pediatrics were identified, which is very interesting information to establish contacts to increase the existing networks, to prevent redundancies, and to take advantage of the new emerging groups. It is necessary to promote the collaboration of Spanish researchers, especially with their international colleagues, since a positive relationship is found between international collaboration and quality and impact of publications measured by citation analysis.

Dental fluorosis in Chilean children: evaluation of risk factors

The purpose of this case-control study was to determine the association between very-mild-to-moderate enamel fluorosis and exposure during early childhood to fluoridated water, mainly through ingestion of powdered milk. Analysis was performed on 136 residents of the optimally fluoridated community of San Felipe in the Chilean Fifth Region, who were categorised into one of three groups according to their age when water fluoridation was introduced in 1986: Group I was born after 1986; Group II was 16-24 months old in 1986; and Group III was >24 months of age. The case and control subjects were selected on the basis of a clinical examination given in July 1996. Dean's scoring system was used to determine fluorosis status. Risk factor exposure was ascertained by a questionnaire used in interviews with mothers of participating children. Logistic regression analysis, after adjustment for confounding variables, revealed that very-mild-to-moderate enamel fluorosis of permanent central maxillary incisors (CMI) was strongly associated both with the age of the subjects when water fluoridation began and with breast-feeding duration for children belonging to Group I. Subjects in Group I were 20.44 times more likely (95% CI: 5.00-93.48) to develop CMI fluorosis than children who were older than 24 months (Group III) when fluoridation began. Subjects who were between 16 and 24 months old when water fluoridation began were 4.15 times more likely (95% CI: 1.05-16.43) to have CMI fluorosis than children older than 24 months. An inverse association was found with breastfeeding duration (OR=0.86, 95% CI: 0.75-0.98) among Group I subjects but not in Groups II and III. Results obtained suggest that the current fluoride concentration in drinking water may be contributing to fluorosis. Further studies will be necessary to determine the relative competing risks of dental fluorosis and dental caries in Chilean children in order to establish the most appropriate water fluoridation level in Chile.

Electrophysiological effects of verapamil on primary and transitional pacemaker cells of the frog heart

1. In spontaneously beating preparations of sinus venosus of the frog Caudiverbera caudiverbera the electro-physiologic effects of verapamil on action potential parameters of both primary and transitional pacemaker cells were investigated. 2. Verapamil in concentrations ranging from 5 x 10(-8)M to 2 x 10(-6)M slowed the sinus rate and blocked impulse initiation. Action potential blockade was accompanied by oscillations of membrane potential and depolarization. 3. During blockade of primary pacemaker cells, pacemaker shift originated the activation of transitional or atrial contractile fibres. 4. Subthreshold concentrations of the drug to induce complete blockade (5 x 10(-8)M) allowed to observe a greater depression of bioelectric cell characteristics in primary than in transitional fibres. 5. Verapamil-induced blockade of transitional pacemaker action potentials was preceded by the appearance of a notch in their upstroke and the persistence of a fast depolarizing section that remained unblocked. This fast verapamil-resistant section of the upstroke was absent in preparations treated with tetrodotoxin (TTX). 6. The results confirmed most previously described actions of verapamil on mammalian sinoatrial preparations and provided a pharmacological dissection of the two slow and fast bio-electric components contributing to the upstroke of transitional pacemaker cells of the frog sinus venosus.